REQUESITION SLIP NAME: DATE: ADDRESS: SEX: AGE: LABORATORY FBS/RBS CBC LIPID PROF PLATELET CNT HDL ESR LDL Hemoglobin Triglycerides Blood Typing Total Cholesterol CTBT BUN PTPA/PROTIME CREA Peripheral BS BUA Urinalysis Liver Profile Micral Test SGPT / ALT Stool Exam SGOT / AST Occult blood Total Protein Pregnancy Exam Bilirubin VDR / RPR Calcium Others Chroride REQUESITION SLIP NAME: DATE: ADDRESS: SEX: AGE: LABORATORY FBS/RBS CBC LIPID PROF PLATELET CNT HDL ESR LDL Hemoglobin Triglycerides Blood Typing Total Cholesterol CTBT BUN PTPA/PROTIME CREA Peripheral BS BUA Urinalysis Liver Profile Micral Test SGPT / ALT Stool Exam SGOT / AST Occult blood Total Protein Pregnancy Exam Bilirubin VDR / RPR Calcium Others Chroride REQUESITION SLIP NAME: DATE: ADDRESS: SEX: AGE: LABORATORY FBS/RBS CBC LIPID PROF PLATELET CNT HDL ESR LDL Hemoglobin Triglycerides Blood Typing Total Cholesterol CTBT
